New

Medical Insurance Manager (2424)

SIU Medicine
$4,244.51 - $4,668.96 Monthly
medical insurance, dental insurance, life insurance, paid time off, paid holidays, sick time, extended sick time, tuition reimbursement, 403(b), retirement plan
United States, Illinois, Springfield
Nov 21, 2025
We recommend using the following browsers to complete the application: Desktop: Google Chrome, Edge with Chromium Mobile: Google Chrome, Safari Description Under the general direction of the SIU Medicine Deputy Director of Insurance Follow- up, the incumbent in this position is responsible for the supervision of the insurance follow up team in Patient Business Services (PBS). The incumbent is responsible for overseeing the daily operations and inventory of the Insurance Follow-Up team. This includes managing a variety of task for the Insurance Follow-Up teams, analyzing denials, looking for trends and payor issues, following up on outstanding claims with insurance payors, overseeing training, updating workflows, reviewing explanation for correct payment, providing support to the staff, assistant manager, the Deputy Director in PBSs and Executive Director of Revenue Cycle. Examples of Duties The following information is intended to be representative of the work performed by Incumbent in this position and is not all-inclusive. The omission of specific duty or responsibility will not preclude it from the position if the work is similar, related, or a logical extension of position responsibilities. 80% Supervision/Administration Provides day-to-day supervision of the Medical Asst-Managers and corresponding staff within their teams. Responsible for interviewing, hiring, overseeing training within the Follow-Up Teams Approving leave time of the Asst-Managers Maintain responsibility for evaluating the work performance of the Follow-up teams and enforcing disciplinary action as required. Plans, organizes, directs and controls the activities of subordinate staff in support of the duties and responsibilities outlined by the Deputy Director or Director. Responsible for the implementation of appropriate operating procedures and controls to assure maximum reimbursement from Managed Care, Commercial, Workers Comp, Medicaid, and Medicare intermediaries. Troubleshoots problems, provides assistance and directs faculty and staff to the appropriate resource to solve issues related to insurance denials and/or payor issues on charges/invoices. Work with Clinical staff either directly or through the Deputy Directors in identifying, developing, and implementing automated systems and processes which enhance the overall effectiveness of the unit and assure optimization of revenues and/or efficient and timely claims submission. Responsible for participating in and/or conducting presentations and/or educational workshops to both faculty and staff. 15% Reimbursement Analysis/Invoice Follow-Up/Receipt Posting Review Managed Care, Commercial, Worker's Comp, Medicare, and Medicaid explanation of benefits (EOBs) to ensure that maximum reimbursement has been received. Follow-up actions include requesting coding reviews, requesting appeals to review boards, requesting administrative hearing, etc. Review and audit in detail receipt listing for accurate posting to patient accounts. This includes posting receipts, discretionary and statutory write-offs as directed. Provide post-audit and quality assurance functions specific to Managed Care, Commercial, Worker's Comp, Medicaid, and Medicare reimbursement. Identify Adhoc reports for special projects and to isolate patterns to be reviewed by Managed Care, Commercial, Worker's Comp, Medicare, and Medicaid specialists, coding staff, administrative staff within SIU Medicine. Submit denial information to the medical coding staff in the clinical departments for review and coding decisions. Track requests for coding review. Resubmit claims based on the coding reviewer response or take write-offs as directed. Request appropriate adjustment/write off for denied charges that do not need medical coding review (non-covered service, untimely filings, etc.) Make appropriate entry of actions taken in the billing system modules. Respond to complex correspondence addressed to the Managed Care, Commercial, Worker's Comp, Medicare, and Medicaid staff 5% Other duties as assigned. Qualifications CREDENTIALS TO BE VERIFIED BY PLACEMENT OFFICER Any one or combination totaling six (6) years (72 months), from the categories below: College coursework in a health-related field, business administration/management, human resource management, or closely related fields, as measured by the following conversion table or its proportional equivalent: 30 semester hours equals one (1) year (12 months) Associate's Degree (60 semester hours) equals eighteen months (18 months) 90 semester hours equals two (2) years (24 months) Bachelor's Degree (120 semester hours) equals three (3) years (36 months) Work experience in supervision or management or other positions of similar responsibility with experience in a healthcare environment working with medical claims, denials, rejections, referrals, and prior authorizations. KNOWLEDGE, SKILLS AND ABILITIES (KSAs) Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership techniques, production methods, and coordination of people and resources. Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluating customer satisfaction. Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process. Extensive knowledge of medical insurance claims processing and Extensive knowledge of medical terminology, referrals, and prior authorizations. Skill in evaluating information to determine compliance with standards. Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, standards and ensuring that lower-level employees are following standards. Skill in personnel resources management through motivating, developing, and directing people as they work, identifying the best people for the job. Skill in monitoring/assessing the performance of self, other individuals, or organizations to make improvements or take corrective action. Skill in identifying the development needs of others and coaching, mentoring, or otherwise helping others improve their knowledge or skills. Ability to train employees and plan, assign, and supervise the work of others. Ability to work collaboratively, building strategic relations with colleagues, coworkers, constituents. Ability to identify complex problems and review related information to develop and evaluate options and implement solutions. Ability to use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems. Ability to use good judgment and decision-making skills while considering potential actions' relative costs and benefits and choosing the most appropriate one. Out of State Applicants that apply to Springfield vacancies in classifications in the occupational area of Professional, Semi-Professional, or Managerial will be subject to the following Condition of Employment: Pursuant to the State University Civil Service System, an out-of-state resident who is hired into this position must establish Illinois residency within 180 calendar days of their start date. This should be listed in the Minimum Qualifications for these vacancies. Supplemental Information If you require assistance, please contact the Office of Human Resources at hrrecruitment@siumed.edu or call 217-545-0223 Monday through Friday, 8:00am-4:30pm. *The mission of Southern Illinois University School of Medicine is to optimize the health of the people of central and southern Illinois through education,* *patient care,* *research and service to the community.* The SIU School of Medicine Annual Security Report is available online at https://www.siumed.edu/police-security. This report contains policy statements and crime statistics for Southern Illinois University School of Medicine in Springfield, IL. This report is published in compliance with Federal Law titled the "Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act." Southern Illinois University School of Medicine is an Affirmative Action/Equal Opportunity employer who provides equal employment and educational opportunities for all qualified persons without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, protected veteran status or marital status in accordance with local, state and federal law. Pre-employment background screenings required.